Hezzell M J, Foster J D, Oyama M A, Buch J, Farace G, Quinn J J, Yerramilli M
Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, UK.
Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Friendship Hospital for Animals, 4105 Brandywine Street NW, Washington, DC 20016, USA.
Vet J. 2020 Jan;255:105420. doi: 10.1016/j.tvjl.2019.105420. Epub 2019 Dec 11.
Pathophysiological cardiac and renal interactions are termed cardiovascular-renal disorder (CvRD). Cardiovascular disease/dysfunction secondary to kidney disease (CvRD), is a leading cause of death in human chronic kidney disease (CKD) patients. The presence and clinical impact of CvRD in dogs with CKD is unknown. We hypothesized that echocardiographic measurements, and cardiac and renal biomarkers, will be altered in dogs with CKD and associated with survival. Eleven dogs with CKD (n = 6 IRIS stage 2, n = 5 IRIS stage 3) and without primary cardiac disease, plus 12 healthy age-matched control dogs, were recruited to this prospective observational study. Dogs underwent standard echocardiography, glomerular filtration rate (GFR) estimation by iohexol clearance, and measurement of plasma cardiac troponin I and N-terminal pro-B-type natriuretic peptide (NT-proBNP), plasma and urinary cystatin B, and urinary clusterin and neutrophil gelatinase-associated lipocalin (NGAL). Values were compared between groups, and their association with all-cause mortality explored. Dogs with CKD had significantly lower GFR and higher NT-proBNP, urinary cystatin B, clusterin, and NGAL, compared to controls (P < 0.05). Echocardiographic measurements were similar between dogs with CKD and controls. Median follow-up time was 666 days, during which six dogs with CKD died. Risk of death was associated with increasing age, serum total protein, and normalized left ventricular posterior wall thickness (LVPWDN) and decreasing bodyweight and packed cell volume. Although baseline differences in echocardiographic measurements were not evident between dogs with moderate CKD and controls, the presence of CvRD was suggested by the association between LVPWDN and survival.
心脏与肾脏之间的病理生理相互作用被称为心血管-肾脏疾病（CvRD）。继发于肾脏疾病的心血管疾病/功能障碍（CvRD）是人类慢性肾脏病（CKD）患者死亡的主要原因。CvRD在患有CKD的犬类中的存在情况及临床影响尚不清楚。我们假设，患有CKD的犬类的超声心动图测量结果以及心脏和肾脏生物标志物会发生改变，并且与生存率相关。11只患有CKD（n = 6为国际肾脏病研究学会（IRIS）2期，n = 5为IRIS 3期）且无原发性心脏病的犬，加上12只年龄匹配的健康对照犬，被纳入这项前瞻性观察性研究。犬接受了标准超声心动图检查、通过碘海醇清除率估算肾小球滤过率（GFR），并测量了血浆心肌肌钙蛋白I和N末端B型利钠肽原（NT-proBNP）、血浆和尿液胱抑素B以及尿液簇集素和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）。对各组之间的值进行了比较，并探讨了它们与全因死亡率的关联。与对照组相比，患有CKD的犬的GFR显著降低，NT-proBNP、尿液胱抑素B、簇集素和NGAL更高（P < 0.05）。患有CKD的犬与对照组之间的超声心动图测量结果相似。中位随访时间为666天，在此期间，6只患有CKD的犬死亡。死亡风险与年龄增长、血清总蛋白、左心室后壁厚度标准化值（LVPWDN）增加以及体重和红细胞压积降低相关。尽管中度CKD犬与对照组之间在超声心动图测量的基线差异不明显，但LVPWDN与生存率之间的关联提示存在CvRD。
